Form NOAA 88-164 NOAA 88-164 Fisherman's Contingency Fund Claim Application

U.S. DEPARTMENT OF COMMERCE

NOAA FORM 88-164
REVISED 05-2018

NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION

OMB APPROVED NO. 0648-0082

FISHERMEN'S CONTINGENCY FUND CLAIM APPLICATION

EXPIRES 05-31-2021

INFORMATION
Claimant’s Name

SSN

Business Name

Tax ID #

Mailing Address

Citizenship

City

State

Zip

Email Address

Occupation
Cell

Vessel Name

Vessel #

Phone

Home Port

Vessel Type

Tonnage

Locational coordinates
of obstruction (GPS)
Did you recover the obstruction?
(Y/N) If yes, keep it as evidence.

Date 15-day
Report filed
Was a Surface marker attached to or near
the obstruction? (Y/N)

If obstruction dragged, at
Do you have photos of obstruction
what location was it left?
&/or damage? (Y/N) If yes, attach.
Describe obstruction and include if surface marker was attached or near the obstruction. State why you believe the
obstruction is associated with oil and gas activities on the Federal Outer Continental Shelf.

Circumstances of Casualty (Damage or Loss)
Date of Casualty
Time of Day
Water Depth

Amount Claimed
Gear Loss
(from page 3)
Gear Damage
(from page 3)
Vessel Damage
(from page 3)

Visibility

Vessel Loss

Vessel’s Speed

Economic Loss
(from page 3)
Fuel
(from page 3)
Other Expenses
(from page 4)

Vessel’s Direction
How much time did
casualty involve?
How many fishing days did
you lose due to casualty?
Explain the Vessel's activity at the time of casualty.

Total

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Explain how the captain and crew responded.

Explain any attempts to retrieve gear. State the number of gear units deployed and the number lost.

Explain the extent of damage.

Explain what captain and crew did after casualty. For example, did the vessel continue to fish or return to port?

If returned to port, why?

How much time did the casualty involve?

Names of other vessels in the vicinity at the time of casualty.

Witnesses
Each claim must contain notarized statements from any material witnesses to the casualty. Statements must describe the
basic circumstances (i.e. who, when, what was lost/damaged, etc.) under which the casualty occurred and any knowledge as
to cause of the casualty. Statements must include the occupational status (i.e. vessel owner, vessel operator, crew, etc.).
Provide the following information and attach the notarized statements. Attached additional sheets if more than 3 witnesses.
Name 1
City

Street Address

I

State

Name 2
City

I

Phone

Street Address

I State

Name 3
City

Zip

Zip

I Phone

Street Address

I State

Zip

I Phone

Fuel – Complete this section if you are claiming for extra fuel consumed as a result of the casualty.
List the dollar amount for fuel you are claiming for extra fuel consumption. Explain how you calculated this amount.

How many days had you been
fishing when the casualty
occurred?
How many extra hours of
running time are you claiming
because of casualty?

On the casualty trip, how many hours
(total) of running time was used to go
to/from your port to casualty fishing site?
What was the price per gallon (receipts
must be submitted) did you pay for the
fuel burned on the casualty trip?
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Economic Loss Claimed
Provide the data for the following five (5) fishing trips: (a) three (3) trips prior to the casualty; (b) the casualty trip; and (c)
the post-casualty trip. Attach copies of the fish trip tickets.
Date of Trip Ticket
Number of Pounds of
Number Days Spent
Dollar Value of Catch
To
From
Fish Caught
Fishing
1
2
3
Total
Average
Take number of days lost fishing due to casualty
and multiply by Average Dollar Value of Catch
Date of Trip Ticket
To
From

=

Number of Pounds of
Fish Caught

Then multiply it by .50
for maximum amount
=
economic loss allowed
Number Days Spent
Dollar Value of Catch
Fishing

4
Casualty Trip
5
Post-Casualty
Claimed Gear – Lost or Damaged
List each gear item for which you seek compensation. Describe item and include quantity and size.
Date of
Replacement
Replacement or
Lost or
Item
Purchase Price
Damaged
Purchase
or Repair Date
Repair Cost

Total
Attach additional sheet(s) if needed. Submit proof of purchase (i.e. sales receipts, affidavits, etc.), an estimate for repair or
replacement, and documentation for the date repair began and ended or date the replacement gear ordered and received.
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Other Expenses
List any other expenses you have incurred as a result of the casualty for which your claim is filed. Submit receipts.
Item
Amount

Other Information
Provide a statement on the amount of time lost from fishing because of the damage or loss and a full explanation of why the
time period is reasonable.

Remarks and additional information.

Statements and Signatures
CRIMINAL PENALTY FOR FRAUDULENT CLAIM. Any person who files a fraudulent claim is subject to criminal
prosecution under 18 U.S.C. Section 284 and 1001, each of which, upon conviction, imposes a penalty of not more than a
$10,000 fine and 5 years imprisonment, or both.
Privacy Act Statement.
Authority: The collection of this information is authorized by Title 45 U.S.C. 1177 and CFR Part 259. The data is for the
evaluation of eligibility for compensation from the Fishermen’s Contingency Fund. Compensation will not be considered
unless all requested information is furnished.
Purpose: In order to determine eligibility for the Fishermen’s Contingency Fund, the NOAA National Marine Fisheries
Service (NMFS) requires financial information, vessel owner contact data, vessel and licensing information, damage
estimates, replacement invoices, verification of payments, fish ticket data, economic and fuel loss estimates, snag
information, and other data as relevant.
Routine Uses: NMFS will use this information to determine eligibility for compensation from the Fishermen’s Contingency
Fund. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be shared
within NMFS’ Financial Services Division. Disclosure of this information is also subject to all of the published routine uses
as identified in Commerce/NOAA-21, Financial Services Division.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will
prevent the determination of eligibility and compensation from the program.
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a
penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of
1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number
for this information collection is 0648-0082. Without this approval, we could not conduct this information collection. Public
reporting for this information collection is estimated to be approximately 8 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the information collection. All responses to this information collection are required to obtain benefits. Send
comments regarding this burden estimate or any other aspect of this information collection, including suggestions for
reducing this burden to the Financial Services Division (F/MB5) Office of Management and Budget, 1315 East West
Highway-13th Floor, Silver Spring, MD 20910, Attn: Elaine Saiz/Financial Services Division Chief and
[email protected].
Confidential name and address information may be released via a NOAA website for informational purposes. All other
data submitted will be handled as confidential material in accordance with NOAA Administrative Order 216-100,
Protection of Confidential Fisheries Statistics. Notwithstanding any other provisions of the law, no person is required to
respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject
requirements of the Paperwork Reduction Act, unless that collection of information displays a currently claim OMB
Control Number.
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SURROGATION AGREEMENT. I, ____________________________________(name) , on behalf of
individual/corporation, in consideration of the compensation received pursuant to the provisions of the Outer Continental
Shelf Lands Act Amendments of 1978, Title IV, from the United States of America, represented by the Secretary of
Commerce, acting by and through the Administrator for the National Oceanic and Atmospheric Administration (the
Secretary) on the date hereof, I do hereby subrogate, assign, transfer and set over to the Secretary and the Secretary’s
successors and assigns, any and all rights and remedies, sums of money now due or owing to and nature, which I have had,
or now have, or may have arising out of the loss, damage or destruction to our fishing vessel or gear for which the
compensation has been granted. I hereby appoint the Secretary, the Secretary’s successors and assigns, myself true and
lawful attorney and attorneys, with full power of substitution and revocation, for me and in my name, or otherwise, but for
the sole use benefit of the said Secretary, the Secretary’s successors and assigns, to ask, demand, sue for the said claim or
claims, or any part thereof.
I agree to provide the Secretary with all available and relevant information concerning the circumstances surrounding the
events leading to the loss, damage or destruction for which the aforementioned compensation has been received. I also
undertake to furnish the Secretary with such affidavits or declarations and to give such oral evidence as the Secretary may,
in his/her discretion, deem necessary for the lawful pursuit of any claim arising from the aforementioned subrogated rights.
In witness whereof, I have hereunto set my hand on the date indicated below.

__________________________________________________
Signature

____________________
D ate

I, ______________________________________ (name), a U.S. citizen, am the _____ Owner _______ Operator of the
________________________________________ (vessel) and have read all of the foregoing statements and supporting
documents relating to this claim, and to the best of my knowledge all statements and documents are true and correct. No
portion of the claimed loss and/or damage may be recoverable through an insurance claim. I also agree to repay all or any
part of the award if the award should for any reason be subsequently reduced.

__________________________________________________
____________________
Signature
D ate
INSTRUCTIONS TO CLAIMANTS
I. GENERAL. The Fishermen's Contingency Fund (FCF) is authorized by Title IV of the Outer Continental Shelf (OCS)
Lands Act Amendments of 1978. Its purpose is to compensate commercial fishermen for damage or loss caused by
obstructions associated with OCS oil and gas activities in U.S. Federal waters. The Program is administered by the NMFS
FCF, Financial Services Division F/MB5, 1315 East-West Hwy, 13th Floor, Silver Spring, MD 20910.
A. PRESUMPTION OF CAUSATION. A presumption that the damage or loss was caused by items associated with
OCS oil and gas activities is allowed if you report the damage or loss to NMFS FCF within 15 days after the date
your vessel first return to port after discovering damage or loss and report the required information. If the report is
not submitted within the 15 day period, the presumption exception will not be allowed and you will have to prove
that the obstruction causing the damage was related to OCS oil and gas activities.
B. NEGLIGENCE OR FAULT. Causalities occurring within a one-quarter (1/4) mile radius of obstructions so
recorded or marked are presumed to involve your negligence or fault.
C. FILING YOUR CLAIM. You must file a complete and accurate claim within 90 days after the date you first
discovered the damage or loss. The term "file" means delivered in person or mailed to NMFS FCF at the address
above. Claims not filed within 90 days may not be eligible for FCF compensation. NMFS FCF suggests that
claims be sent by registered or certified mail with return receipt requested.
D. FAILURE TO MEET THE FILING REQUIREMENTS. NMFS FCF may reject your Claim if it does not meet
the filing requirements. If your claim is rejected, NMFS FCF will give you written notice of the reasons for
rejection. If you do not refile an acceptable claim within 30 days after the date of this written notice, you will not
be eligible for FCF compensation unless there are extenuating circumstances.
E. AGGREGATING CLAIMS. If more than one commercial fisherman suffers loss or damage from the same
casualty, the losses should be included in one claim application.
F. AMENDMENT TO CLAIMS. You may amend your claim any time before the NMFS FCF initial determination.
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II. WHAT CAN BE CLAIMED. You may file for actual and consequential damages as follows:
A. ACTUAL DAMAGES. The lesser of the gear's repair or reasonable replacement cost.
B. RESULTING ECONOMIC LOSS. Up to 50% of gross income loss, as estimated by NMFS FCF, you will lose
because of not being able to fish, or having to reduce fishing effort, during the period before the damaged or lost
fishing gear is repaired or replaced. This period must be reasonable and supportable by the facts and documents.
C. ATTORNEY, CPA, AND CONSULTANT FEES. Reasonable fees paid to an attorney, CPA, or other consultant
for the preparation of your claim. NMFS FCF will determine what amounts are reasonable. You will not be
compensated for these fees if the claim is denied.
D. CONSEQUENTIAL (OTHER) DAMAGES. Damage or loss, except personal injury, that was incurred as a
consequence pf the fishing gear damage or loss.

III. NEGLIGENCE CLAIMANT. An award will be reduced to the extent that the damage or loss was caused by your
negligence or fault. Basic grounds for finding a claimant negligent or at fault are listed in the FCF Regulations.
Negligence of the owner or operator of fishing gear will affect crew member awards.
IV. INSURANCE PROCEEDS. An FCF award will be reduced by the amount of any compensation you are entitled to
receive from insurance.
V. PENALTY FOR FALSE CLAIMS. Any person who files a fraudulent claim is subject to prosecution under 18 USC
sections 2187 and 1001, each of which, upon conviction, imposes a penalty of not more than $10,000 fine and 5 years
imprisonment, or both.
VI. REQUIRED DOCUMENTATION. Documents which must be submitted with your claim are:
A. Proof that you purchased the fishing gear damaged or lost. Submit copies of the best evidence available (i.e. sales
receipts, affidavits, cancelled checks, or other evidence).
B. Written estimate showing repair or replacement costs for the damaged and/or lost fishing gear.
C. Prior to payment of any claim, claimant must submit documentation that the replacement gear ordered and
received and/or the date gear repair began and ended.
D. Trip tickets for the three (3) vessel trips immediately before the trip during which the casualty was discovered, the
casualty trip, and for the trip immediately following the trip during which the casualty occurred.
E. Photographs (if available) of the obstruction and of any damage to your gear.
F. Signed notarized statements from each witness.
G. The name, address and phone number of each person, if any, to whom you have given oral or written notice that
such person caused or may have caused the damage or loss, together with a copy of any written notice given each
such person and a statement whether each such person has paid or will pay you for any portion of your claim.
VII. NMFS PROCESSING OF CLAIMS.
A. NMFS FCF will process your claim and mail a written initial determination to you within 60 days of the date it is
complete with regard to the information required for compensation from FCF. An initial determination will state:
(1) If the claim is disapproved, the reason for disapproval, or
(2) If the claim is approved, the amount of compensation and the basis on which amount was determined.
B. If you disagree with the initial determination, you or any other interested person who submitted evidence relating
to the initial determination, may request a review of the initial determination.
(1) Your written request must be postmarked within 30 days of the date of the initial determination and must fully
state your reason(s) for disagreement; and
(2) If a petition for review of an initial determination is timely filed, the NOAA Fisheries Assistant Administrator,
or designee, will conduct a review of the initial determination, and issue a final determination within 60 days
after the day on which the request for review of the initial determination was received.
C. If no request for initial review is submitted within 30 days, the initial determination will become a final
determination.
VIII. PAYMENT OF AWARD FOR CLAIM. When an initial determination becomes final, NMFS FCF shall disburse the
amount awarded.
IX. SUBROGATION. NMFS must obtain a subrogation agreement signed by you which assigns to the NMFS your rights
against third parties and provides that you will assist NMFS in any reasonable way to pursue those rights.
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Authority: Public Law 97-212 (43 USC 1841 et seq.). Regulations: 50 CFR Part 296.
Contact information: NMFS F/MB5 FCF, 1315 East West Highway, 13th Floor, Silver Spring, MD 20910. Telephone:
301.427.8725. Fax: 301.713.1306. Additional information at www.nmfs.noaa.gov/mb/financial_services/fcf.htm

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